Endophthalmitis associated with microbial keratitis

I. U. Scott, Harry W Flynn, William J Feuer, S. C. Pflugfelder, Eduardo C Alfonso, Richard Forster, Darlene Miller

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Abstract

Purpose: The purpose of the study is to investigate possible risk factors, organisms cultured, and visual acuity outcomes of endophthalmitis associated with microbial keratitis. Methods: Records were reviewed of all patients with both positive corneal and positive intraocular cultures at the Bascom Palmer Eye Institute between January 1, 1990, and March 31, 1995. Results: Thirteen (92,9%) of 14 patients identified had documented keratitis before the diagnosis of endophthalmitis was made. Thirteen (92.9%) patients recently had used 1% prednisolone acetate eye drops, 2 (14.3%) received oral prednisone, and 5 (35.7%) were being treated for systemic conditions associated with relative immune dysfunction. Eight (57.1%) patients had a history of ocular surgery, and seven (50.0%) had wound abnormalities. Eight (57.1%) patients lacked an intact posterior capsule, four (28.6%) had a corneal perforation, and three (21.4%) had a history of dry eye. Gram- negative organisms (7), Staphylococcus aureus (3), streptococcal species (2), and fungi (4) were the most frequently isolated organisms. Coagulase- negative staphylococci were not isolated. Six (42.9%) patients achieved a post-treatment visual acuity of 20/200 or better. Three (21.4%) patients underwent enucleation or evisceration. Although not statistically significant, there was an association between appropriate initial antibiotic therapy and improved visual outcomes. Conclusion: Patients in whom endophthalmitis associated with microbial keratitis develops have a frequent history of corticosteroid use, systemic conditions associated with relative immune dysfunction, lack of an intact posterior capsule, dry eye, wound abnormalities, and/or corneal perforation. In general, agents cultured consisted of organisms less frequently reported to be the causative agents in series of postoperative and post-traumatic endophthalmitis. Post-treatment visual outcomes generally were poor.

Original languageEnglish
Pages (from-to)1864-1870
Number of pages7
JournalOphthalmology
Volume103
Issue number11
StatePublished - Dec 14 1996

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Endophthalmitis
Keratitis
Corneal Perforation
Visual Acuity
Capsules
Eye Abnormalities
Ophthalmic Solutions
Coagulase
Wounds and Injuries
Prednisone
Staphylococcus
Staphylococcus aureus
Adrenal Cortex Hormones
Fungi
Anti-Bacterial Agents
Therapeutics

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Scott, I. U., Flynn, H. W., Feuer, W. J., Pflugfelder, S. C., Alfonso, E. C., Forster, R., & Miller, D. (1996). Endophthalmitis associated with microbial keratitis. Ophthalmology, 103(11), 1864-1870.

Endophthalmitis associated with microbial keratitis. / Scott, I. U.; Flynn, Harry W; Feuer, William J; Pflugfelder, S. C.; Alfonso, Eduardo C; Forster, Richard; Miller, Darlene.

In: Ophthalmology, Vol. 103, No. 11, 14.12.1996, p. 1864-1870.

Research output: Contribution to journalArticle

Scott, IU, Flynn, HW, Feuer, WJ, Pflugfelder, SC, Alfonso, EC, Forster, R & Miller, D 1996, 'Endophthalmitis associated with microbial keratitis', Ophthalmology, vol. 103, no. 11, pp. 1864-1870.
Scott IU, Flynn HW, Feuer WJ, Pflugfelder SC, Alfonso EC, Forster R et al. Endophthalmitis associated with microbial keratitis. Ophthalmology. 1996 Dec 14;103(11):1864-1870.
Scott, I. U. ; Flynn, Harry W ; Feuer, William J ; Pflugfelder, S. C. ; Alfonso, Eduardo C ; Forster, Richard ; Miller, Darlene. / Endophthalmitis associated with microbial keratitis. In: Ophthalmology. 1996 ; Vol. 103, No. 11. pp. 1864-1870.
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abstract = "Purpose: The purpose of the study is to investigate possible risk factors, organisms cultured, and visual acuity outcomes of endophthalmitis associated with microbial keratitis. Methods: Records were reviewed of all patients with both positive corneal and positive intraocular cultures at the Bascom Palmer Eye Institute between January 1, 1990, and March 31, 1995. Results: Thirteen (92,9{\%}) of 14 patients identified had documented keratitis before the diagnosis of endophthalmitis was made. Thirteen (92.9{\%}) patients recently had used 1{\%} prednisolone acetate eye drops, 2 (14.3{\%}) received oral prednisone, and 5 (35.7{\%}) were being treated for systemic conditions associated with relative immune dysfunction. Eight (57.1{\%}) patients had a history of ocular surgery, and seven (50.0{\%}) had wound abnormalities. Eight (57.1{\%}) patients lacked an intact posterior capsule, four (28.6{\%}) had a corneal perforation, and three (21.4{\%}) had a history of dry eye. Gram- negative organisms (7), Staphylococcus aureus (3), streptococcal species (2), and fungi (4) were the most frequently isolated organisms. Coagulase- negative staphylococci were not isolated. Six (42.9{\%}) patients achieved a post-treatment visual acuity of 20/200 or better. Three (21.4{\%}) patients underwent enucleation or evisceration. Although not statistically significant, there was an association between appropriate initial antibiotic therapy and improved visual outcomes. Conclusion: Patients in whom endophthalmitis associated with microbial keratitis develops have a frequent history of corticosteroid use, systemic conditions associated with relative immune dysfunction, lack of an intact posterior capsule, dry eye, wound abnormalities, and/or corneal perforation. In general, agents cultured consisted of organisms less frequently reported to be the causative agents in series of postoperative and post-traumatic endophthalmitis. Post-treatment visual outcomes generally were poor.",
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